Permit •
•
' CITY OF T ELECTRICAL RESTRICTED ENERGY PERMIT
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;' COMMUNITY DEVELOPMENT Permit #: ELR2010 00119
'x- f4, Date Issued: 07/06/2010
"Ti ;ARD 13125 SW Hall Blvd., Tigard.OR 97223 503.639.4171
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Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9785 SW WASHINGTON SQUARE DR D12
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Radio Shack
Project Description:
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 07/06/2010 $135.68
CARLSBAD, CA 92008 12% State Surcharge - Electrical 07/06/2010 $16.28
PHONE:
Contractor:
J K BUDDY SYSTEMS
11209 SE WOOD AVENUE
MILWAUKIE, OR 97222
PHONE: 503 - 654 -2630
FAX:
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $151.96
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective. Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and at other applicable law.. At work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is .suspended for more the 180
'days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA's 2- 001 -0100. • n- - •. of.the rules or direct questions to OUNC by calling 503.246.6699 or 1.801.3 +•.2344.
.. :4411111111111111 ` - '- Issued By / y �
Perm Signature: . � .A /`
OWNER INSTALLATION ONLY /
The installation is being'made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION, ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permifcard shall be kept in a conspicuous place on the job site until completion of, the project.
Approved plans'are required on the job site at the time of each inspection.
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A . Electrical Permit Application ,1" ^ a� ', , , u �, +' ' ' u ' h 'a FOR;01'1 ICE. USEI,ONL 1 ', r ^ . -
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City of Tigard Date : Permit No.: i
III
° 13125 SW Hall Blvd., Tigard, OR 97223 ' Pl R ev i ew - ��,i Uv
0 Other Permit: /' / .- Phone 50 3 6 394171 Fax: 503.598.1� DateB : t" �� • � � �tA Clly.
T I I G A R D Inspection Ltne 503.639 4175 Q1Q Date Ready/By: El See Page 2'for
i Internet: www.tigard- or:gov O C' {- Notified/Method: BM Supplemental Information
TYPE-OF U .�� , .` PLAN .REVIEW r , n r •
❑ New construction dition/alteration/re , ` e"Fd v�' Please check all that apply (submit 2 sets of plans w /items checked below):
l ❑ Service or feeder 400 amps or more ❑ Building over three stones.
• ❑ Demolition ❑
C� 1 ` ` ^` V Other: ` ? where the available fault current ❑Marinas and boatyards.
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C ATE G OR Y 'OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
,,
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- .and -2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Emergency system. larger separately derived system.
JOB SITE 3NFORMATION�'�AND- -LOCATION
1 .1 r T ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job nod: Job site address:TJ 5 SW �S CI; vY "1 . 100HP or more. occupancy.
I 1 ❑ Six or more residential units.
0 facilities. ❑ Recreational vehicle parks.
City/State/ZIP: I 7 � ❑ Supply voltage for more than
ty ` a� d c"\ ` q 7a. ^3 � 1 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 6 [Project name: '� ' S G l-� ❑ Service orfeeder 600 amps or more oc. : . :FEE SCHEDULES '
Cross street/directions to job site: Description 1 Qty. 1 Fee. j Total
.. , New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Lirtiited energy,
abo s 67.84
.DESCRIPTION 'OF-WORK ( 4 )
Limited energy, multi - family 67.84 2
CO OjtAin I a " CI residential (with above sq. ft.)
1 \ Services orfeeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑' TENANT ; 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601.amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone:'( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on.property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps fo 599 amps 168.54 2
Branch circuits — new,'alteration, or extension, per`panel
Owner signature: Date: A. Fee for branch circuits with
y = •• _.
® APPLICANT 10 aCONTACT PERSON; - above service or feeder fee, each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
1y dwelling, service andlor feeder
Phone: ( • ) . Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
; ' CONTRACTOR., ` ' , Signal circuit(s) or limited- energy 2
Business name: K 4.01 (A_� S' C S panel, alteration, or extension. Page 2 l •J5 t Gr 2
COO Q Each additional inspection over allowable in any of the above
Address: /..j 20 ci SE COO 0 / 1- U \ Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: WI l ' ( (r( °1 IC ( -e 0 l ' Investigation (1 hr min) 66.25/ hr
,n / Industrial plant (1 hr min) 78.18 / hr
Phone: (S03) '7 So C) 0 Fax: ( ) Inspections for which no fee is •
specifically listed (% hi min) 90.00/ hr
CCB Lic.: 796 ( 7 Electrical Lic3 -3C) C Suprv. Lic.: y2-� E ELECTRICAL'P..ERM1T..�FEESt' 2 ,.
. h �� `' 7/1 1/ 7 11 /1/ Subtotal 17�r�
Suprv. Electrici ig ure, required'
• / Plan review (25% of permit fee):
Print name:�0� (� I l <y1 e l p / / Date:0 t7 / 6 / (D State surcharge (12% of permit fee): i t ,
TOTAL PERMIT FEE: t V
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: / —� �(� / .Date: * Number of inspections allowed per permit.
I:\Building\1'ermits\EL -1 ermi d /01/04 � — 1 " 440- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL; WORK .QNLY
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COIVIIVIER'CIAL WORK;ONL'Yc _._
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
/Other �ilfn�•�CJ�
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1`\ BuildingWermits \ELC- PermitApp.doc 10/01/09